Payment Submission Form

Please fill out ALL of the fields below completely.Print, sign and date the form at the bottom and then FAX this page to us at (856) 435-3399.You will receive an e-mail within one business day as your receipt.

Name *

Street Address *

(This should be where you would like your documents sent.)

City *

State *

Zip Code *

Email *

Phone *

Type of Payment *

Confirmation Number: (Use last name if none available) *

Destination *

Your agent at Circle Travel: *

Are you purchasing insurance?

Must initial if waiving:

Insurance is highly recommended, and cannot be added on AFTER deposit paid. If insurance is waived, portions of package price may be non-refundable; please ask for details. If you are choosing insurance, please make sure to add the insurance cost to your deposit amount below, if it is not already included.

Amount of payment:$ *

* Must be in USD

Credit Card Type:

Check if check/debit card:

Check/Debit Card

(If this is a check or debit card, please check with your bank that you are not exceeding a daily spending limit on the card)

Credit Card Number: (xxxx-xxxx-xxxx-xxxx) *

(Please note: No third party credit cards accepted.)

Expiration Date: *

Expiration Year: *

3 digit security code: (on back of card after 16 digit CVC#) *

Name of cardholder as it appears on card: *

Billing address of card (leave blank if same as above):

Street

City/State/Zip:

Enter any notes or requests, such as smoking or non-smoking, bed, view or floor preferences, special occasions, applicable frequent flyer numbers, etc. in the space below.

By submitting, you certify that you are the cardholder and are authorizing Circle Travel or its chosen Tour Operator/Wholesaler to charge the listed amount to the credit card.

You certify that you have verified that all information contained in he confirmation you received is accurate. You also certify that you have read the Terms & Conditions. Cancellation penalties may apply. Insurance is not refundable.

Please be aware that you will not see a charge from Circle Travel on your credit card statement; the charge will come from the Wholesaler (Travel Impressions or Disney Cruise Line, for example) and/or the airline directly (U.S. Air or Air Jamaica, for example).

If paying by other method (money order or cashier's check ONLY), please complete, print, and sign this form, and send with payment via courier service (UPS, Fed Ex, Airborne, etc. - do not use regular mail) to the address listed above.

Payments must be received no later than 5:00pm EST on the due date listed on your confirmation or will be considered late, and rates/availability may not be able to be guaranteed.